Minimally invasive surgeries are well known and often involve an endoscopic or arthroscopic procedure where incisions are minimized and the surgery is performed within the body using one or more portals for insertion of instruments together with a camera or scope for viewing and conducting the procedure. Having avoided opening up the surface of the body, the surgical site may remain constrained by overlying tissues or other portions of the body that would have otherwise been lifted off of the site in an open procedure. These overlying portions of the body may obstruct or occlude access to the surgical site. Additionally, open and scope procedures alike may involve adjacent, overlying, or underlying tissues or other portions of the body that may obstruct or occlude access to the surgical site. Moreover, visualization may be limited due to over-crowding in certain constrained spaces or corporeal epicenters.
Several devices and methods are known in the art for facilitating access to a surgical site during endoscopic or arthroscopic procedures. These devices may include volumetric expansion devices such as inflatable retractors or other laterally expanding devices, such as slidable expanding sleeves. Methods may include tissue dissection.
Various problems or disadvantages can be found with these current options. Regarding inflatable retractors, they may not be effective in areas where the surrounding tissue is more rigid because the potential for sufficient volumetric expansion is not available. An additional concern is that inflatable retractors may be susceptible to rupture. A rupturing retractor can cause a sudden shift of instruments relative to anatomic structures which may damage anatomic structures such as blood vessels, nerves, other non-target structures, or even improperly damage the target structure. Moreover, a rupturing retractor may release a gas into the surgical site causing discomfort or even dangerous absorption into a blood vessel. The collapsing surgical site may leave the field obscured and the surgeon may not be aware of the damage caused. Additionally, depending on the extent of the rupture, portions of the retractor may even get lodged in crevices in the body. Regarding slidable expanding sleeves, positioning them once expanded can be difficult and may cause friction and abrasion of tissues. Regarding dissection, this approach is often not desirable because the obstructing tissue is healthy and because bleeding and/or scarring could cause further complications.
There is a need in the art for a device to displace tissue surrounding a surgical site rather than dissecting that tissue. Additionally, there is a need for the device to be capable of providing more net space when additional total space is not available. Moreover, there is a need for a device that allows for adjustability of the device and the tools used along with the device to appropriately access the surgical site.